High-Dose Hyaluronidase for Late-Onset Vascular Complications Following Hyaluronic Acid Filler

Late-onset vascular complications (VCs) following hyaluronic acid (HA) filler injections are rare but can result in significant morbidity if not promptly recognized and managed. We report a case of a 41-year-old woman who developed delayed VCs 28 h post-injection, unresponsive to low-dose hyaluronidase. Escalation to high-dose hyaluronidase (6000 IU), combined with platelet-rich fibrin (PRF) and hyperbaric oxygen therapy (HBOT), led to full recovery without adverse effects. This case highlights the clinical challenge of delayed VCs and the potential efficacy of aggressive, multimodal management.